Iron Triangle of Healthcare

There is a common term in consulting that highlights there is a triangle relationship between resources, time and scope.  If you want to decrease resources, you need to subsequently decrease either quality or scope.  If you increase scope, you need to also increase resources to maintain quality.  It is an age-old adage that also rings true with healthcare.

A recent article in Journal of the American Medical Association highlighted a similar triangle within healthcare that included access, cost and quality.  The similar examples hold true.  If you increase access to all, you must also increase cost which may adversely impact quality.  If you want to increase quality, you probably will impact cost. 

After reading the article several weeks ago, something didn’t seem right but some a simplistic example.  We often recognized that new tools or processes within consulting/implementation could dramatically increase quality and overtime would be more cost effective with fewer resources.

As usual, I was not alone in the thinking and came across a compelling article by David Liu, MD.  The article highlights that disruptive technologies and innovative solutions will transform the industry over time as it did for personal computers, air travel and many other industries.

The question that this all begs me is what will that solution be?  As Dr. Liu points out, who will lead the charge?  We have many different stakeholders in the industry and each has a perspective on what that solution should be and how to drive it.  Who wins?  For the point of discussion, let me throw out some of solutions that have been explored in recent years.  I would be interested in hearing which of these is truly transformative and which are just ‘re-packaging’ the old.

  1. Cash-carrying/bartering:  Back to the days of Dr. James on main street doing house calls and being paid by a quarter cow.  Will removing the bureacracy of insurance claims, payments, coding and other components, dramatically improve the industry?  Will it not only be more cost effective but also increase the quality of care?
  2. ACOs:  Is moving the risk closer to those that manage the care truly going to revolutionalize the industry?  Can it be implemented in a cost effective manner?  Are there only certain organizations, regions, etc. that make these viable?
  3. Health Benefit Exchanges: Are the regulations around these exchanges worthwhile and effective in driving down cost and expanding access?  Will those efforts reduce the quality of care? 
  4. EDI/EHR Integration:  Technologies that integrate clinical data could revolutionize the industry.  But what if these systems do not holistically integrate?  What if you ATM card only worked at your bank’s ATMs?  How would that help with access?  And does the cost reflect the improved quality gained by these innovations?
  5. The convergence of the physician and payer organizations.  Cutting out the middle men should reduce costs, right?  And the integrated care should improve quality right?  But what about access?  And what if the integration creates a monopoly? 

I am sure there are many other options.  But if nothing else…food for thought.

The future of Joel

As Google Buzz rolled out and I made the switch to an Android phone (Motorola Droid), I struggled with where to invest my time and social media. I went through a previous effort to determine where to update virtually. Here is what it has come down to for me personally.

1. LinkedIn: This is purely my professional space. I do not plan on updating status or other personal information on the site. This is publicly searchable and I engage here with other professionals in the health care and consulting industries.

2. Twitter: While I still am not enamored with Twitter I see that it has become a viable social networking solution. My only plan here is to update specific Buzz posts as well as any posts on this blog here. It will hopefully drive traffic to this site versus the other way around.

3. Facebook: This is my purely personal space. While I have connected with a select few business professionals here, I may scale back. Here I update with family pictures, notes on events, connect with formal classmates. Folks..pretty sure Facebook is here to stay.

4. Buzz: This will be a mix between personal and professional. The beauty of Google is its ease of sorting between showing personal information to friends and professional information to the public. I plan to update some buzz posts on to twitter but this is still a wait-and-see product for me.

5. Ning: I have a variety of Ning Networks (Church, Blazeman Warrior, I Am Tri) that I engage for social networking with specific groups. Its group functions are currently superior to what is offered on Facebook but maybe that will be taken over some day?

5. Abandoned Services: Here are the list I have almost completely abandoned for one reason or another:
– MySpace
– Orkut
– Message Boards
– Chat Rooms

6. Services I have no desire to use:
– Foursquare
– Windows Live Spaces
– MyLife
-Friendster

Thoughts from the readers here? Which services to you use and which ones do you find most useful (both personally and professionally).